Low Risk of Severe Infections Observed in Afebrile Infants with Pustules: Study

A recent multicenter study published in the recent issue of Pediatrics journal suggests a thorough infectious evaluation and herpes simplex virus (HSV) testing for all the afebrile infants presenting with blisters, massive pustules and rashes. This study was conducted at six universities from September 1, 2013 to August 31, 2019 to track the incidence of serious infections in these young patients and provide guidelines for clinical evaluation and treatment.

The study reviewed the medical records of infants and children 60 days of age and younger who received pediatric skin care information. Of the 879 communications included, 183 infants were afebrile and presented with pustules or vesicles. The results did not have a positive cerebrospinal fluid culture or blood culture for bacteria. Also, positive urine cultures were not found in infants with skin infections which indicated that no severe bacterial infections might attribute to these skin infections.

One of the main findings of this study was that herpes simplex virus infection was found in nine babies which accounted to 7% of the group. The majority (77.8%) of these were term babies, while the remaining 22.2% were premature. This highlights the importance of considering HSV infection in infants with all-cause pustules and blisters. Also, five children were diagnosed with angioinvasive fungal disease where all of them were very premature babies (less than 28 weeks of gestational age).

These outcomes illuminate the need for greater surveillance and comprehensive evaluation of infant diseases associated with these skin symptoms. Despite observing no serious bacterial infections, the study found that 53% of infants received parenteral antibiotics. These high rates of antibiotic administration reflect a careful approach by clinicians, given the high risk of infection in this vulnerable population. The findings of this study highlights that, with the exception of HSV infection, the risk of isolated pustules and vesicles was low in infants 60 days of age or younger. However, this points to maintain an index of suspicion in singleton infants, especially the premature babies.

Overall, these findings provide important guidance to effectively manage the afebrile infants with dermatological concerns. This also highlights the importance of evaluating target diseases and avoiding unnecessary antibiotic use in low-risk cases. 

Reference:

Yun, S., Cotton, C., Faith, E. F., Jacobs, L., Kittler, N., Monir, R. L., Ravi, M., Richmond, A., Schoch, J., Workman, E., Zucker, J., Hunt, R., & Lauren, C. T. (2024). Management of Pustules and Vesicles in Afebrile Infants ≤60 Days Evaluated by Dermatology. In Pediatrics. American Academy of Pediatrics (AAP). https://doi.org/10.1542/peds.2023-064364